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July 20, 2010 -- Various market forces are working to push radiologists away from their referring physician clients. But with extra attention and maybe a little bit of new technology, radiology groups can thrive in the current environment and foster healthy and ongoing relationships with their referring colleagues.

How exactly can radiologists do this? Through a range of tactics that include paying more attention to their interpersonal skills and using new technology to make themselves more available to referring physicians, according to several experts who spoke on the topic to AuntMinnie.com.

The 3 characteristics of success

A successful referring physician relationship has three basic characteristics: ability, affability, and availability, according to Richard Duszak, MD, an interventional radiologist with Mid-South Imaging and Therapeutics, a private practice in Memphis, TN, and current procedural terminology (CPT) advisor and chair of the Committee on Coding and Nomenclature with the American College of Radiology (ACR) of Reston, VA.

"The questions [in referring physicians' minds] are these: Am I comfortable with the quality of the radiologist's report? Is the radiologist easy to get along with? Does he take time to educate me rather than being gruff or dismissive?" Duszak said. "Will this radiologist's practice provide the service when I need it, in a timely manner?"

But the priority order in which referring physicians put these three qualities can be surprising.

"If a radiologist has the attitude, 'I'm great, and they have to take me when I'm available,' that's not so successful," Duszak said. "When people answer customer surveys, right or wrong, they're mostly focused on whether the person providing the service has been friendly and available. It's taken for granted that the service will be competent."

Introduce yourself

At Massachusetts General Hospital (MGH) in Boston, the radiology department pays for marketing services specifically to welcome new physicians. When a new doctor arrives, he or she is greeted with contact and protocol information -- and a fleece sweatshirt with the MGH radiology department's logo on it, according to Giles Boland, MD, vice chair of radiology at MGH.

"Referring physicians see radiologists less and less," Boland said. "We're in these dark rooms, sending images electronically everywhere and anywhere. We've withdrawn ourselves, reading from home, not going to as many conferences. How can we build rapport and trust under these circumstances? We have to actively counter the electronic trends that push us further away from referring doctors."

Boland suggests radiologists become part of the wider clinical team by attending case conferences, meeting with the hospital's chiefs of service, and making personal calls to referring doctors on pressing cases. This is the way to protect turf, according to Boland.

"If we're seen as commodities, people can take over our turf. But if we're part of the bigger hospital team, we can protect that turf."

Be available

"The biggest way to establish and maintain relationships with referring doctors is to be onsite," said Craig Kamen, MD, president of Radiology Associates of Jeffersonville, IN. "Referring physicians want to see you, they want to know who you are, get to a certain comfort level with you. It's a lot easier to look at a radiology report written by someone they already know and trust than by some radiologist they don't know in some far-flung part of the world."

Radiology Associates provides in-house coverage until 11:00 p.m. on weekdays and 8:00 p.m. on the weekends. It employs a teleradiology company for after-hours reads, but the teleradiologists only perform preliminary interpretations, Kamen said.

"We do all the final reads. We're always the backup," he said. "That way, if the ER doctor gets a report and needs some follow-up, he can get one of us on call."

Keep up the technology

The radiologist's main "product" is the report, and what's important to referring physicians is how quickly the radiologist can get that report into the referring doctor's hands. Sharing information with referring physicians has come a long way from the days of hiring couriers to physically transport films between offices, and is currently transitioning from sending CDs with patient information to the referring doctor to Web-based portals that can exchange information.

Indeed, new technology is making these portals even easier for referring doctors to use. Outpatient Imaging Affiliates (OIA) of Nashville, TN, uses Web portal technology that features a "zero-client approach." In contrast to a thin client system, which runs a full operating system to connect to other computers, the zero-client system doesn't do this; instead, its "kernel," or the central component of its operating system, initializes the network, begins networking protocol, and handles display of the server's output. This means no browser compatibility or security and workflow issues arise when users need to download plug-ins, making radiology information more easily available to referring doctors.

"Our referring docs don't want faxed reports or CDs with images," said Jeff Tumbleson, vice president of IT for OIA. "In the past, Web portals got derailed with Microsoft IE7 and IE8 updates. And installing the portal would take an OIA employee 30 to 60 minutes per site. Now, it takes about 10 minutes to bring our clients up to speed."

"Referring doctors don't want to read an essay," he said. "Radiologists should move to standardized reporting, with templates for different modalities and voice recognition. If a referring doctor is getting reports from eight different radiologists [in a department or practice] and each one has a different style, reading them is less efficient. You want the referring physicians to say, 'These people are good. I love how concise their reports are.' "

By focusing on developing friendly interpersonal connections and producing reports that referring doctors find effortless to access, forming long-lasting professional relationships with these physicians can have long-term positive effects on a practice's health, according to Boland.

"Once you lock in a referring physician, it's hard for a competitor to come along and woo that person away, even if the competitor has the best PACS, because the relationship has been established," he said.